Migraine treatment was once a primitive practice, largely misunderstood and underestimated. Decades ago, the only medication prescribed for migraine pain was similar to over-the-counter aspirin. By the 1980’s the pharmaceutical industry began to soar and new pain medications were developed to assist the terminally ill during their final days of life.
Referred to as opioids, these powerful pain medications became a prescribed antidote to chronic pain sufferers like migraneurs. Codeine and oxycodone hydrochloride (OxyContin) allowed migraneurs to rejoin their life but at the heavy price of severe side effects and the general feeling of numbness.
Today, the migraine community is fighting for more awareness and making great strides to improve the selection of treatment options. Migraine care has shifted from dealing with symptoms once they occur to preventing their occurrence in the first place. This new approach to treatment is known as prevention therapy and it has many faces. If you’re looking to stop pain before it begins and decrease migraine frequency, here’s where to start.
The First Step…
Prevention therapy is based on ones understanding of the patterns and triggers of their migraine episodes. Before an effective preventative regimen can be crafted, migraine sufferers must get to know their condition and how different aspects of life can influence the onset of their migraine episodes. Knowing when to expect pain means knowing when to ramp up defenses.
- Hormones – Especially for women, hormones may play a factor in the onset of migraine episodes. Do your migraines seem to occur during a certain time of the month? Do you take birth control and has that had an affect on your migraine episodes? Are you pre-menopausal, menopausal or post-menopausal and has this changed your symptoms?
- Diet – Studies suggest that foods containing the chemical ‘Tyramine (which occurs naturally as foods age) could trigger migraine symptoms. This includes aged cheeses, cured meats and smoked foods. Artificial sweeteners, alcohol and caffeine have also been know to elicit migraines.
- Sleep – Patients lacking restful sleep as part of their routine also put themselves at risk for triggering a migraine.
- Environment – Some individuals experience seasonal migraines. Others feel attacks in conjunction with a storm front. It is believed that as a storm develops there is a buildup of positive ions in the air, which may increase serotonin levels in the body that are linked to migraine episodes.
Keep a migraine diary to determine whether these influences have an affect on your migraine frequency and severity. Once triggers and patterns are identified, patients and physicians can detect ‘windows of opportunity’ where prevention therapies can be utilized. The goal is to take minimal amounts of medication with as few side effects as possible.
Types of Prevention Therapy
There are volumes of prevention therapies surfacing in the migraine world. Some therapies are taken daily while others are taken during predicted times of vulnerability.
Non-Migraine Anti-Inflammatories
A daily dose of anti-inflammatory medication might be all you need to keep another attack at bay or at least lessen frequency. This prevention therapy reduces blood vessel inflammation near the brain that can contribute to migraine pain.
Trexima
Trexima is a new drug currently under FDA review. It is a combination of Imitrex (sumitriptan) and Naproxen Sodium (anti-inflammatory). Studies show that Trexima prevents blood vessel dilation and the release of an inflammation-triggering enzyme. Knowing when to expect symptoms is crucial to the success of this prevention therapy, as it is not intended for daily consumption.
Protein Inhibitors
When a migraine is developing and blood vessels begin to inflame, a protein is released called Calcitonin Gene-Related Peptide (CGRP). A protein inhibiting medication lowers these levels to lessen migraine frequency.
Supplements
With the approval of your doctor, supplements can be used by pregnant women, taken in conjunction with other medications and show little to no side effects. Supplements also benefit individuals with pre-existing conditions that disallow them to use prescription migraine medications.
- Magnesium – Studies show that during a migraine attack, magnesium levels in the brain are low, especially for hormone related migraines. Restoring the balance may improve symptoms.
- Feverfew – An herb that seems to reduce frequency of migraine attacks in patients who take it daily.
- Coenzyme Q10 – A vitamin-like supplement that has been proven to reduce migraine frequency up to 50% in some patients.
- Butterbur – A perennial shrub that also works to reduce frequency of migraine attacks in patients who take it daily. After three months, some patients experienced a 58% reduction in episodes.
- Riboflavin – Also known as vitamin B2, shows similar results as Butterbur and Coenzyme Q10 when taken daily as a prevention therapy.
Drugs Created for Other Disorders
Drugs created for other conditions may also be prescribed for daily use to help diminish migraine episodes. However, some patients experience side effects that make these drugs a less appealing preventative option.
- Anti-seizure drugs – like Topamax and Depakote, prescribed for epilepsy.
- Beta-Blockers – Such as Inderal, prescribed for high blood pressure or irregular heart rate.
- Calcium Channel Blockers – like Cardizem, prescribed for high blood pressure or irregular heart rhythm.
- Non-steroidal anti-inflammatory drugs – commonly known as Aleve or Anaprox.
- Tricyclic Antidepressants – Such as Elavil and Norpramin.
Botox Injections
Thought to prevent certain chemicals from reaching nerve endings (by which migraine pain can evolve). Botox is injected in up to 31 sites around the head. It is administered during a single 10-minute session and can be repeated every three months. Botox has minimal (if any) side effects and may help to reduce severity and frequency of migraine attacks. However, it is not suggested for use unless other treatments have failed.
Physical Intervention
A number of physical interventions are also showing promising effects on migraine frequency and intensity, especially for individuals who have not responded well to medications and other forms of treatment.
- Chiropractic therapy – realigns the vertebral column to relieve tension on the central nervous system.
- Acupuncture – uses ultra-fine needles inserted at specific points to increase blood flow and more naturally dilate constricted blood vessels.
- Neurostimulation – Uses an implanted device to send light electrode pulses directly to the nerves associated with sending pain signals to the brain.
If you are interested in learning more about prevention therapy, speak with your doctor or a migraine specialist. A thorough examination of your medical history as well as an in-depth understanding of your migraine triggers and patterns will be critical to formulating a regimen that meets your unique needs. Not all therapies play well together, so you’ll want the expertise of a professional to aid in your selection of therapies to try.
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